Near-fatal asthma attack

My 19 year old son who has had chronic asthma since he was born had a really bad asthma attack a couple of months ago and I need some help. He had bad asthma for about 3 days resulting from being around too much smoke. He was not taking his corticosteroid inhaler at the time and was just using his ventolin inhaler for relief. He was at a friends and they were drinking some beer. He had taken several (12) puffs over the past couple of hours but couldn’t get relief. He was intoxicated but not severely so he decided to run the 1-1/2 km home. The temperature was near freezing but he is in good physical shape and runs regularly despite having asthma (most of the time his asthma is controlled by preventative medicine). He was almost home when he said everything went black and then he remembers waking up at the hospital. I was at home and decided to pick him up at his friends house because I knew he had to work in the morning and needed a ride home because I drove him out there because he knew that they would be drinking and he couldn’t drive. When I got to his friends they told me that he had already left and I thought I must have just missed him on the grid road. I drove home but he still wasn’t home and then I got worried. I drove back to his friends and saw him on the side of the road. I tried to wake him but I couldn’t. His friends help me load him in the car and I took him to my friends who is a nurse and First Responder. She said that he needed an ambulance, so I call 911. His face was dark around his mouth and his breathing was shallow. His pulse was weak and rapid. Over 170 beats. Three other First Responders came while we waited for the ambulance. His breathing became shallower and suddenly stopped and then his pulse was hard to find. They decided to start CPR. They did CPR for about 4 or 5 minutes when his pulse became stronger and he started breathing shallow again. He tried to cough and gag. They bagged him with oxygen and breathed for him. He started to have seizure-like activity. He would stiffen up, roll over to the side, and stop breathing. He was turning blue and they would give him more oxygen and it would subside. Each seizure lasted for about 6-10 seconds. He had about 4 before the ambulance came. These continued on and off for about 30 minutes. The EMTs told me that they had to breath for him all the way to the hospital and then when he got to the hospital the EMTs said that they could tell he was responsive and started to breath on his own. He had another seizure-like episode in the ER and the EEG said that it was not a seizure. My son soon became responsive and could remember passing out but nothing since. The doctor checked him over for about 5 minutes and by then I got to the hospital and he told me that my son had pseudo seizures and that he was screaming out for help. The EMTs were horrified by his diagnosis and told me to get another opinion. He admitted him to the hospital and in the morning our GP came and said that he wished we would have called him the night before and he agreed that this was not pseudoseizures and that he had a severe asthma attack. During the night his wheezing started (I guess in a severe asthma attack wheezing stops and the breathing muscles give up and can’t breath on their own). Soon after he had another couple asthma attacks and needed medicine and stayed in the hospital for several days before he got better. Please can anyone help me with whether or not these were pseudoseizures because from what I have read about them they need to be looked after by a phsyc. I just find it hard to believe that these were pseudo seizures after having a bad attack like that. Has anyone else ever experienced these hypoxic seizures during an attack?

Thanks in advance. (sorry for the long post)

12 Replies

oldestnewest
  • If you look up on google under brittle asthma you will find lots of info on severe life threatening asthma attacks. Many experience the wheeze stopping when the attack becomes life threatening. This is called status asthmaticus i have copied a web page for you to read this may have happened but ou need to speak to your healthcare provider about possible brittle asthma or whether it was the culmination of events.

    webhealthcentre.com/centers...

  • Hi Stevie, sorry to hear about what you're going through with your son.

    Of course, it's very difficult to make a judgement hearing the story second hand, and I'm not giving a medical opinion! (I am a medical professional but I'm posting here as a fellow severe asthmatic and would never presume to make an on-line diagnosis!)

    However, I would say, and I'm sure others on the forum would agree, that what you're describing does indeed sound like a near-fatal asthma attack.

    It does not at all sound like pseudoseizures! Whilst it's possible (although rare) for someone to slightly drop their oxygen saturations with pseudoseizures, people don't normally go blue or dark around the lips, and they definately don't stop breathing! Also, pseudoseizures don't tend to occur whilst the person is alone, as they are triggered by a (usually subconscious) unresolved pyschological conflict or a desire for attention. I'm horrified that a doctor would diagnose pseudoseizures in a young man without doing extensive tests to rule out any physical cause - it's supposed to be a diagnosis of exclusion, and certainly in my hospital (which is a tertiary Neurosciences referral centre in the UK) would be diagnosed by a consultant Neurologist after extensive (often inpatient) investigation.

    I've had hypoxic seizures whilst having a severe asthma attack, it is somewhat rare but not unheard of, and I wouldn't be suprised if quite a number of other people on this board have had them too. Even if the person is being bagged or having oxygen, they still can occur as the chest is so tight that it is impossible to properly oxygenate by bagging them.

    You are right as well that in a severe attack wheezing stops (if you're not moving much air then you're not going to wheeze... it's a bit like playing a muscial instrument!) - in fact a 'quiet' or 'silent' chest is one of the text book signs of a lifethreatening attack. It's a sign that the respiratory muscles are becoming too exhausted to move air and that the person might have a respiratory arrest. (It should also be said that some asthmatics *never* wheeze)

    Please please get a second opinion as soon as possible! Sorry to be blunt, but having had one attack like this, your son is at increased risk of dying from an asthma attack. He needs to be managed by a Respiratory Physician (Pulmonologist? I don't speak Canadian!), preferably one with an interest in severe/brittle asthma.

    The good news is it sounds like there might be some modifiable things that triggered this attack - being around smoke, not taking his steroid inhaler. Hopefully with proper assessment and treatment he will never have another attack like this... but he needs assessment and a management plan in case he does.

    Feel free to ask any other questions, and good luck

    Emily H

  • When oxygen saturations drop low FITS can and do happen!

    Its only happened to me twice!

    But I am lucky that our little town has only 3 first responders who ALL know me and know how to handle my care!

    Here in UK its known as *silent chest* when the muscles become to tired nad wheezing stops!

    This happens alot in me and many others at a guess!

    For me thought if Ihave silent chest I am on my way to ITU or our local NIVU (non-invasive vent unit)!

  • Thank you so much everyone.

    I have already decided to get a second opinion as our GP was afraid that Don also had arrythmias that night and he is not sure which came first ""the chicken or the egg"" so as to speak. He does think that his over-use of his asthma reliever inhaler caused the arrythmias that night and that as long as he continues with his flovent inhaler that this shouldn't be as bad the next time around. I just want to make sure that my son fully understands the depth of this situation before he goes off to college next year and won't have me around to assess his asthma for him. Thank you again for answering my questions for me so quick. I am sure that I will be back with many more for you. It has been a very stressful couple of months.

  • Brttle Asthma

    I was wondering if Brittle asthma can develop in young adults when they only had severe cough variant asthma as a child. His asthma seemed to act up everytime he got a virus or during seasonal allergies. His asthma was mainly cough variant with wheezing only present during the night and early mornings. He has been on corticosteroids since about the age of 4. He takes them for 3 months and off them for 3 months and this seemed to keep things under control. He also received flu shots since he was 12 to prevent the serious flus. But now since he has turned about 17 his asthma seems to be getting much worse. He is also triggered more by allergens and sometimes even exercise which was never a problem as a child.

    I also had a question about some asthmatics being more tolerant of their severe symptoms than other patients and sometimes they are risking their health by not paying close enough attention to their symptoms. Our GP mentioned that maybe my son is not aware of his worsening symptoms and that really has me worried. Has anyone else encountered this before. Thanks.

  • maybe this is slightly different but in response to your last post stevie, my son is very unaware that he is unwell and my self and the cons have decided that the most likely eason for that is the fact that he is quite symptomatic every day so he isnt aware when the wheeze is worse or his chest feels tighter - he still plays and asks for toys even when (like last time) he had no breath ounds in left side at all, it was his right lung that was doing all the work, most people ""should"" (if theres such a word concerning asthma) be splatted by then - sats 89% on 4L O2, resps 65 etc but he was asking for toys!! im not asthmatic myself so i dont know how it feels to go through the satges of an attack but i do know that some people are unaware of the symptoms, michael is proof of that!!

  • Stevie and Kirtstenc, I have happily got on a train (at Newton Abbot) and headed to London fully expecting to go on a weekend break to Harrogate with no air entry in lower 2/3rds of the lungs. I had no wheeze and it was only cos I was so short of breath my GP on a routine ""lets make sure you have your drugs right"" visit listened to my chest. She sent me straight to A&E where I did such a good impression of being OK I was allowed to sit in majors waiting for a trolly until I totally splatted totally splatt in my case is just stopping breathing. Ok so I was pretty determined to get to Harrogate and I knew I was not well but not that unwell. But I really did not know how bad I was. So just because you are used to your asthma and well over 30 years old does not mean you will always spot what it is going on. Sometimes I need those around me to point out the blindingly obvious.

    Bex

  • Stevie, as the others have said it is definately possible for even an 'experienced' asthmatic to underestimate their symptoms!

    Until a few months ago I would have said I've always had quite good awareness of how bad I was, but recent events have proved me wrong! I had an attack at work back in January, which I thought I'd managed to settle with a few nebs. I decided to go home and made my excuses to my registrar (and I did feel like I was making excuses) not because of the asthma but because I thought I was too shakey to carry on working. I then walked to my car and started to drive home, as I was leaving the site I realised that my oxygen sats must be low cos I couldn't see too well. I was still going to carry on home when it occured to me that driving AWAY from the big hospital where I work perhaps wasn't the best idea! I parked the car (scraping it against a wall!) and somehow managed to walk back to A&E, I even stopped off to use the toilet and brush my hair. When I arrived in A&E I was shocked at how bad my sats and blood gases were, I really didn't think I was too unwell. Of course the first thing the A&E staff did was call the medical registrar down, she was seriously unimpressed that I hadn't told her earlier how much I was struggling. I honestly didn't know though, I almost carried on working.

    Several of my attacks recently have been similar, often I've been in two minds whether to go in at all, then when I get there I'm surprised to find that sats/gases are awful and have ended up in HDU/ICU. I've learnt to take more notice of my husband and of objective things like how easily I can climb the stairs and how much relief I get from a neb. Husband now refuses to take me in by car as I've given him some nasty surprises by getting worse very quickly on the way. Because I am a Dr people often expect me to have a good handle on how abd I am and to be 'sensible' - well, it doesn't really work like that!

    As for developing brittle asthma having had asthma earlier in life, I think a lot of us can probably relate to that. I developed asthma age 14, and brittle asthma age 19. I think it's quite a common pattern and no-one really knows why it happens that way. I think also that when you've grown up having asthma and seeing it as an inconvenience but not something that has a serious effect on your life, it can be very difficult to realise that it has changed into something different. It's tempting to say 'oh, it's just asthma, I've dealt with this before' and underestimate it. We all know people with asthma who are well controlled and pride themselves on not 'letting it' change their lives, as if we had a choice about whether it changes our lives! I think there's a part of me that still believes that if I put my mind to it, and exercise, eat well etc, I can be free of this! Denial is a very powerful, at times necessary, but at times dangerous, coping mechanism.

    I wish you and your son all the best as you adapt to this

    Emily H

  • hellooo

    Emily, I have had similar experiences too!

    I was a little tight at the chemist, had a neb, got meds, drove home, parked the car perfectly (or so my neighbour told me later) got out and collapsed!

    Other neighbour managed to get my O2 which helped til the paramedics arived, loaded me into ambulance where I promptly stopped breathing! (Not for long but parapanics bit scared!) I had been fine for days before!

    I now use adrenaline in the form of an Epipen if I go off like that!

    I find that I can cope with going down hill gradually when having a chronic episode but when well, I crash fast!

    I still do underestimate my symptoms though!

    I am aware , or try to be aware that when I am well, that I don't over do it, easier said than done as I am prone to Brittle type 2 episodes as well as my brittle type one-ness!

    I was diagnosed as asthmatic at 18, but tried to carry on as normal as possible but by 24 yrs diagnosed as brittle !

    I think just being aware of symptoms helps, even if you carry on doing things and living life as normal as possible. Having a protocol for treatment is important too!

    KAte

  • I have an Epipen for the sudden onset attacks too... always puzzles new GPs as I'm not anaphylactically allergic to anything, so they can't understand why I need it. I can't say I've ever noticed much effect from using it though.

    Husband always tells Ambulance Control that I've had arrests in ambulances in the past, but they still persist in sending technician ambulances from time to time instead of paramedics - any ideas to get round that one? We really need someone who can intubate, cos I'm nearly impossible to bag with a mask when I'm at that stage! Husband says he's going to learn to do it - not so silly, cos he's a medical student, but not sure I fancy it!

    Thankfully haven't had an attack quite that scary for nearly two years... and hopefully I won't again!

  • It really surprises me how many doctors and medical personell in Canada know absolutely nothing about asthma. It is really quite scary here in Saskatchewan (a province in Canada). Right now we have a shortage of nurses and doctors and some Emergency rooms in hosptials have actually had to close down. I have learned over the years to research asthma on my own to make sure that I am up to date with all the new medicines and procedures. I was very fortunate to have a great children's doctor for my son when he was younger so he always stressed the need for the cortisone treatments. But he has since moved away and now we are under the mercy of a family doctor. Our family doctor is also an anethesiologist so he is knowledgeable about respiratory problems. I have also been reading the epilepsyforum.org.uk and I was also surprised to see how knowledgeable everyone over there was about epilepsy too. You people in the UK are years ahead of us in terms of medical care. I wish I could bring my son there for treatment.

  • Hi Stevie wonder

    just wanted to say hi from another canadian! I agree that asthma care here may not be as good as it seems to be in the uk.

    sorry to hear about your son's awful attack, hope he is doing ok.

    XX Brynne

You may also like...